[Metabolic effects of oral contraceptives].

cannot always be proved despite the common association with poor oral hygiene, alcoholism, and fits, but at least the abscess is secondary to pneumonia. A. J. Block and colleagues8 note the declining frequency of this disease and could find only 79 examples in 'a recent ten-year review of patients admitted to the Johns Hopkins Hospital. Experience in Britain must be similar owing to the early treatment with antibiotics of patients threatened with pneumonia. Though surgical treatment was formerly to be preferred, the management of this formidable disorder is now almost entirely by medical means. The choice of antibiotic is influenced to some extent by the nature of the bacterial flora in the sputum. Often no pathogens can be isolated, especially if antibiotics are given before bacteriological tests are done. Among the aerobic organisms that may be found are pneumococci, streptococci, klebsiellae, and miscellaneous Grampositive and Gram-negative bacteria. Anaerobes should always be sought and are usually present when the sputum is foetid. In practice penicillin is the antibiotic of choice, given in a dose of 4-8 million units a day for three to six weeks according to the severity of the infection, with a smaller dose subsequently if healing is delayed. Bronchoscopy is usually desirable, to exclude other disease such as carcinoma. Postural drainage and the inhalation of warm, humidified air are valuable accessory measures. Surgical resection has little or no place during the first few weeks of treatment, unless a suspicion of carcinoma arises. Later it may be necessary for chronic sepsis in a destroyed lung with bronchiectasis, or possibly for recurrent infections of an open cavity which persist despite prolonged medical treatment.